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HomeMy WebLinkAboutBLDG-22-002148 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK EE'll CITY YARMOUTHk_ MA DATE October 14,2021 PERMIT# BLDG-22-002148 JOBSITE ADDRESS 15 HEATHER LN OWNER'S NAME GOODWIN BARBARA J G OWNER ADDRESS C/O BRETT GOODWIN 36 GETTY CIR FAIRFIELD CT 06824 TEL _ TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO El FIXTURES FLOORS--0 BSM 1 2 3 ! 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ ROOF TOP UNIT TEST 1 .UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION:Underground propane gas line. Running from tank to the house. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Christopher Davis LICENSE# 3173 SIGNATURE MP❑ MGF 0 JP❑ JGF 0 LPG! © CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: Eastern Propane ADDRESS. PO Box 1207, CITY South Dennis STATE MA ZIP 02660 TEL FAX —I CELL EMAIL S310N M31A3i NVld #11M3d $ 33d ❑ 11WH3d 3H1 SV SAS NOIJVOIlddV SIHl oN seA S31ON NO1103dSNI IVNId AINO 3Sf1 H0103dSNl HOd 30Vd SIH1 S3lON NO1103dSNl SVO H9f10H